Intervention effectiveness reducing disability stigma in sub-Saharan Africa: Systematic review.

Background: To reduce stigma, there is a need to understand where stigma exists, how it affects different populations, and what interventions have proven effective in reducing stigma. Objectives: To synthesise evidence on intervention effectiveness in reducing disability-related stigma in sub-Saharan Africa. Method: We conducted a comprehensive search of nine databases, supplemented by grey literature, references and expert consultations. Two authors screened, extracted and appraised studies. Interventions were categorised according to the Behaviour Change Wheel framework, and synthesised narratively from those with a low and medium risk of bias. Results: Out of 15 studies, eight studies (four each with low and medium risk of bias) reported positive effects, seven found education and training effective, either alone or with other interventions. One study observed positive effects from combining education with communication, enablement and persuasion. Of the five studies with mixed effects (medium risk of bias), four employed education and training alongside other interventions, and one combined education with modelling, persuasion, enablement and communication. Two studies (low risk of bias) reported null effects when combining education, training and service provision with other interventions. Conclusion: High-quality research on the impact of stigma interventions in sub-Saharan Africa is limited. Challenges include defining stigma, proving intervention effectiveness, and the varied target groups, settings, intervention types and metrics used to measure stigma change. Contribution: This study highlights the need for and provides the rationale for increased methodological rigour and theoretical grounding in the evaluation of stigma-reduction interventions, and full and transparent reporting of all results.